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as <br />ORANGE COUNTY JAIL <br />SICK CALL REQUEST <br />CC: <br />Da[c: Timc: _am/pm <br />O~cct Namc __ <br />Medical Offsitc Notiticd: yes ~ no _ Uau:/'Timc Notified <br />Inmate Transported to Hospital: yes _ no __ <br />Subjective: <br />Objective: T- P-_R-_B/P- <br />Name: <br />DOB: , <br />SS#: <br />Wt- Allergies <br />Asscssrticnt: 1. 5. <br />1. _ C,. <br />3. ~ 7, <br />4. R• <br />Plan: 1. <br />1. <br />3. <br />4, <br />S. <br />medication orrlercd <br />-RTC Cvr P/IJ <br />_R'TC pm <br />-sent to ER <br />-sent. for Xtay <br />-return to jail area <br />-jail mcdic:al supcrvisipn recommended <br />_rcfcr to dental <br />_rcfcr to psych <br />outside referral: <br />where: <br />ATTACHMENT #i <br />